Provider Demographics
NPI:1417503533
Name:PRATZ, JENNY M
Entity Type:Individual
Prefix:MRS
First Name:JENNY
Middle Name:M
Last Name:PRATZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:735 N HENDERSON ST
Mailing Address - Street 2:
Mailing Address - City:RUSK
Mailing Address - State:TX
Mailing Address - Zip Code:75785-1131
Mailing Address - Country:US
Mailing Address - Phone:903-393-3623
Mailing Address - Fax:
Practice Address - Street 1:735 N HENDERSON ST
Practice Address - Street 2:
Practice Address - City:RUSK
Practice Address - State:TX
Practice Address - Zip Code:75785-1131
Practice Address - Country:US
Practice Address - Phone:903-393-3623
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-14
Last Update Date:2020-09-03
Deactivation Date:2020-06-04
Deactivation Code:
Reactivation Date:2020-09-01
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home